“Operational management has to understand that this is difficult,” she said. “It requires a tremendous amount of focus and articulation. You cannot improve quality from the middle at any permanent level. Be honest about what areas need to be addressed.”

The place to start, she said, is to make sure everyone in a facility is familiar with terminology and definitions in assessments such as MDS 3.0.

Klusch also said medical directors play an important role in enforcing quality measures. In facilities that have interim or consulting medical directors, permanent staff members must bring them up to date on quality-related policies. Both parties need to be open to accepting feedback and criticism as well, she noted.

McKnight's Super Tuesday webinars are an extension of the annual McKnight's Online Expo. They offer providers an opportunity to learn about hot topics of the day and earn continuing education credits for free. The next Super Tuesday webinar, which will focus on survey issues, will take place July 12. Free registration will take place at www.mcknights.com.